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The White Paper on Social Care is coming “very soon” and promises to strengthen carers’ rights but appearance of a funding solution to the impending crisis in adult social care looks increasingly unlikely. Despite the ‘Quad’ (the regular meeting of the Prime Minister, Deputy Prime Minister, Chancellor of the Exchequer and Chief Secretary to the Treasury that discusses important coalition issues) discussions last week over the government’s position on Dilnot and funding reform, hopes of even having sight of a progress report on social care funding are fading fast. It looks like there may not be any progress on addressing the funding crisis in adult social care until the autumn at the earliest.

It is in this expectant and what is feeling like an increasingly hopeless atmosphere that the Local Government Association has issued its stark warning about social care funding – either we reform the system now or fundamental change will be needed to the way local services are funded and organised and or to statutory and citizen expectations of what councils provide.

The LGA projections show that even if social care demand is met (and this will still only be services for a minority of people) there will be a likely funding gap of £16.5 billion a year by 2019/20. What this means is that there will be hardly any money left at all for all other council services like libraries, housing, parks, playgrounds, street lights, community centres, leisure centres to a name a few.

The projections are based on the fact that central government funding for local government has already been cut from 29.7bn 2010/11 to £24.2bn in 2014/15 and that there will be further reduction to around £17.6bn by 2020 in line with Departmental Expenditure Limits set out in the Budget 2012.

The LGA projections appear to leave local government with two choices. Either maintain spending on social care and reduce spending in other areas which will drastically impact our communities or distribute spending across social care and other services. This would leave more vulnerable people with care and support needs with inadequate services or without any services at all, which is why the LGA have put it quite simply – “Without money and reform, there is no solution”.

This is really bad news for many carers who are already battling on a daily basis to get the care and support that they and their loved ones need. At the many events during Carers Week, it was made clear to me that many carers are incredibly worried about the future and how they will cope with the costs of care. They experience a lot of anxiety about their own ability to fund the care their loved ones needs and about financial restraints on the services they rely on. One carer explained “the day centre is very important for my son but also for me – it really is the best respite for a carer”. Someone else commented that the centre offering many of the activities that she and her husband take part in is closing. She’s not sure whether there will be anywhere else to go.

Carers Week was all about the fact that carers have poor health outcomes. But doesn’t it seem odd that despite the Government making it clear that they think carers should get breaks and that their health should not suffer, carers are actually experiencing high levels of stress and anxiety about funding for the services that their loved ones need?
Contradiction is at the heart of Government’s policy making on adult social care – they are willing to overhaul the complex and messy legal framework and willing to look at strengthening carers’ rights to assessment and support, but currently there is no way of funding the increase in demand for care and support. This will make it extremely difficult to fulfil carers’ rights. Of course, we welcome the Government’s “determination” to do more for carers but the legal reforms alone will not result in access to high quality care and support.

Carers know only too well that, without a funding solution for adult social care, they will continue to worry about the future because they will be left responsible for meeting the care needs of their family member of friend. We know that many of those being cared for are receiving the bare minimum from local services. This increases carers’ responsibility which is why they constantly tell us what they really need is more support for the person they care for. If the Government is serious about making support for carers a reality then it’s time to listen to them and have that difficult conversation about how we’re really going to pay for adult social care.

I have changed Andrew Lansley’s mind on the NHS White Paper; single-handedly and with only one simple question. Devastating.

You may be asking how you have not read about this in the papers or heard it on the news, when this is obviously such mammoth news. Well, what I changed his mind on may not actually be so mammoth.

Lansley proposes in the White Paper that local authorities will be able to commission Health Watch to provide information, advice and advocacy for patients regarding health care. Health Watch will replace Local Involvement Networks (LINks). No mention was made of local authorities being able to commission other organisations to do this.

I think that local authorities should be able to commission whoever they want and it may be other organisations are better placed in the community, and it may be more effective to fund more than one organisation to provide these services. So, this is what I asked him at a conference in July.

He said it was a good question and one he hadn’t thought about so he would.

At the Conservative conference, Andrew Lansley was at a reception we jointly hosted and I ended up speaking to him briefly. So I recounted our exchange in July and wondered if he had come to any thoughts on this. He said that yes and that they would be advising local authorities to commission whoever they thought was best placed to deliver information, advice and advocacy and that funding more than one organisations would give patients choice.

So, that was that – I had changed Government policy on the future of health care in England. I don’t think it’s one that will make Newsnight, but if it means that carers can get good information and advice because our Carers’ Centres and local Crossroads Care can get funding to provide this, then it will hopefully be at least a small positive.

Thankfully, the birthday card I got at work yesterday included some humourous messages from colleagues giving me comic relief from the Government’s White Paper on restructuring the NHS in England. The White Paper is obviously important, but it’s just not the most fun read in the world.

In a nutshell, the proposals are:
• GPs will commission the vast majority of all health services for patients and carers meaning Primary Care Trusts (PCTs) will vanish. A NHS Commissioning Board will oversee GP commissioning.
• There will be a new Public Health Service with local Directors of Public Health being appointed jointly with local authorities, who will have new Health and Wellbeing Boards to replace Health Overview & Scrutiny committees.
• Patients should have a choice of providers – so not just NHS organisations
• More information should be shared with patients and carers and decisions taken jointly with health professionals – no decision about me without me

I don’t think the question should be whether GPs being responsible for commissioning is a perfect structure (it really isn’t) but whether it is better than the alternatives. Not everybody seems convinced of that either.

However, proposals for more patient and carer involvement and a new performance framework that focuses on outcomes for patients rather than processes should be welcomed.

This focus on the duties of health services is timely given Barbara Keeley MP’s Bill in Parliament today proposing that all health services should be required to identify patients who are carers or have a care, and consider the carers’ needs. The Bill would also require schools to have a policy to identify young carers – something which we have campaigned on.

The Bill has received support from MPs in the Conservative (Tony Baldry MP), Liberal Democrat (Annette Brooke MP) and Labour parties (Diana Johnson MP + others), plus Caroline Lucas MP of the Green Party. The NHS has a history of neglecting carers and it is imperative that carers are not further forgotten during and after any restructuring. This Bill could ensure that doesn’t happen.